Role of Self-Care in Management of Diabetes Mellitus

Diabetes Self-Management

Many people have heard of diabetes mellitus and that it’s related to blood sugar. However, not many understand the epidemiology of this disease. Diabetes is a complex chronic illness that redefines a patient’s definition of normalcy. In basic terms provided by the CDC, ‘it affects how your body turns food into energy’ (‘Diabetes Homes’, 2017). Food that is consumed is broken down into glucose (sugar) and processes into your blood, then, the pancreas releases insulin (a hormone) which allows cells to accept glucose and is used for energy.

When a person has diabetes, they may either need insulin because the body (pancreas) doesn’t secrete it (Type 1) or the body is not making enough insulin (Type 2) (‘Diabetes Homes’, 2017). In addition to this, it can affect a multitude of organs including, the heart, skin and of course pancreas. According to a study performed by Kent, D’Eramo, Stuart, McKoy, Urbanski, Boren & Lipman, ‘the prevalence of diabetes rapidly rising, it is expected that the disease will affect one-third of adults in the United States by 2050’ (2013).

Thus, education regarding diabetes is vital for diagnosed individuals. Diabetic self-management (DSM) has been at the forefront of patient education in order to help increase the quality of life. Because of this, it is imperative that examine the patient’s point of view regarding their self-management of diabetes. My nursing diagnosis is diabetes self-management related to educational discrepancies as evidenced by poor diabetic outcomes.

Understanding the goals of diabetic self-management as healthcare members will allow us to better comprehend what information to relay to our patients.

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The goals of diabetic self-management are outlined as: ‘the American Association of Diabetes Educators (AADE) has identified reducing these risks as one of the AADE7 Self Care Behaviors that is essential for effective patient-centered diabetes mellitus self-management. These 7 behaviors (healthy eating, being active, monitoring, taking medication, problem-solving, healthy coping, and reducing risks) are individualized to meet a patient’s unique needs through diabetes self-management education and training (DSME/T), an ongoing process in which diabetes educators facilitate the knowledge, skill, and capabilities necessary for individuals to practice effective diabetes self-care’ (Kent et al., 2013).

It is known that diabetes can physically affect a person’s wellbeing, however, other aspects of a person’s life can also pose a factor when evaluating how education should be relayed. This is where all members of the healthcare team come into play. Evaluation of how a patient learns and is able to absorb information is key to successful education.

Evaluating Health Literacy

Health literacy is indicative of the level of understanding of an illness. Low health literacy can be ‘associated with poor health outcomes and poor use of health care services’, according to Kim & Lee (2016). Because diabetes is a chronic illness, it is important that patients have an adequate understanding of their condition. ‘The risk of complications from diabetes is higher among patients with low health literacy’ (Kim & Lee, 2016), thus finding ways to educate individuals on their diabetes self-management needs to be a priority. Suggested ways to inform patients on their management is by ‘using plain language, focusing on actions, limiting the number of messages, acknowledging cultural differences, supplementing instructions with pictures, and checking that patients understand’ (Kim & Lee, 2016). Along with this, socioeconomic and minority status may interfere with education. ‘For example, individuals of minority status, those having lower incomes, and females tend to have higher rates of suboptimal diabetes mellitus outcomes and experience higher rates of diabetes-related complications’, as studied by Fritz (2014).

Communication can prove as a barrier of care because the patient may not be able to comprehend the information provided if not in their native language. ‘Addressing language and cultural differences in communication with patients from ethnic minority groups by language assistance, improvement of cross-cultural communication skills, or considerations of cultural beliefs and customs was categorized as ‘language or cultural consideration’ (Kim & Lee, 2016).

There are many outliers as to why a patient may not have received or comprehended education fully, but it is known that patients within these populations are often times the ones that have more complications related to diabetes later on. ‘High rates of diabetes mellitus diagnosis and poor diabetes outcomes are particularly significant in low-income, socially disadvantaged populations in the United State’, according to Fritz (2017). However, as a nation, we have been working towards improving the care provided to these populations. A study by White, Manning, Brawer & Plumb stated, ‘reducing the disease and economic burden of diabetes and improving the quality of life for all persons who have or are at risk for diabetes is one of its 2020 goals’ (2014).

Individuals that are in a lower socioeconomic status are considered higher risk for lack of resources; ‘Decades of research have shown that low socioeconomic status predisposes to poor health across multiple dimensions; recent work focuses on reducing the negative health impacts of social determinants by implementing interventions tailored to high-risk populations, such as low-income adults with diabetes’ (Seligman, Smith, Berger & Waxman, 2018). There are mixed reports of if we are reaching our goals, and if we are adequately accommodating to the populations at risk.

Availability of adequate food choices

Though education for self-management has been geared toward this population, food insecurity (‘the lack of consistent access to enough food for an active, healthy life’), has been a negating factor in DSM, according to Seligman et al. (2018). Diabetic individuals are educated on the importance of a well-balanced ‘healthy’ diet in order to help manage their diabetes. However, ‘diabetes appropriate diets are more expensive and often financially out of reach for food insecure households’ (Seligman et al., 2018). Thus, leading to poor management of diabetes. Along with this, there is also the concern of ‘cost-related medication nonadherence, poor clinical follow-up because of competing time demands, depression, and increased hypoglycemia risk’ (Seligman et al., 2018).

In response to these burdens that food insecure households face, ‘food banks have emerged as a potential partner in addressing challenges with traditional diabetes interventions’ (Seligman et al., 2018). Food banks often serve areas that have ‘vulnerable populations’ and there is an ‘opportunity to reach patients who are not presenting regularly in clinical settings expands capacity for improving population health and reducing health disparities’ (Seligman et al., 2018). While food banks are not available in every area, it is an intervention worth expanding on.

Are we educating correctly?

According to White, Manning, Brawer & Plumb, increased education regarding self-management has shown ‘to improve long-term complications associated with disease morbidity and mortality, and diabetes self-management education (DSME) has emerged as a significant intervention to promote disease management’ (2014). A correlation has been identified between DSM education and a decrease in diabetic complications (White et al., 2014). Unfortunately, there is evidence that ‘although it is well documented that diabetes education contributes to improved health outcomes, only one third to one-half of individuals with diabetes mellitus in the United States receive diabetes self-management education’ (White et al., 2014). As stated previously, there have been efforts in place to provide education on DSM for high-risk populations.

However, there are also issues with patient compliance in receiving this education. ‘Little is known about the reasons for non-attendance among persons with diabetes referred to self-management education’ (Schwennesen et al., 2016). Patients have opted out of receiving education for various reasons, i.e. illness, schedules, lack of perceived benefit and content (Schwennesen et al., 2016).

Often times we focus on the idea of educating patients, but knowing their reasoning for not receiving the education is also a vital piece in evaluating a patient’s plan of care. As Schwennsen et al. studied, they had patients verbalize that appoints for education due to ‘throat infection’ or perceived thoughts of ‘I didn’t think I needed it… I think there are people who are worse off than me’ (2016). As healthcare providers, it is in our scope of practice to clarify misconceptions patients may verbalize. Education is at the center of all care, as well as listening to patient concerns and acting on them.